Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hos...Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hospital establishments in Ziguinchor. Materials and Methods: This was a retrospective, descriptive, multicenter study from the period of January 1, 2017 to December 31, 2021. Patients over 15 years of age admitted for occlusive syndrome in the two surgical departments of the Ziguinchor regional hospitals were included in the study. Epidemiological, diagnostic, therapeutic and evolutionary data were studied. Results: Acute intestinal occlusions accounted for 8.3% of admissions. A total of 163 patients were enrolled, 61.9% were men, sex ratio of 1.6. The mean age was 48.7 years. The average consultation time was 74.8 hours (3.12 days). The total occlusive syndrome was in 48.5% of the cases. Abdominal pain was present in 87.1%, vomiting in 74.2%, cessation of matter and gas in 60.7% and meteorism in 36.2%. Biological lab tests reported hyperleukocytosis in 28.1% of the cases. Abdominal CT scans were performed in 71.2%, confirming the diagnosis in 90.5% and determining the etiology in 93.1%. The zone of the obstruction in the small bowel was 62.7%, and in the colon in 37.3%. Functional occlusions accounted for 22.7% of cases and mechanical for 77.3%, including 120 cases of strangulation occlusion (95.2%) and 6 cases of obstruction. Etiologies were dominated by adhesions and/or fibrous bands (61.2%). Medical treatment resolved the occlusive syndrome in 9.2% of cases, instrumental treatment in 17.1% and surgical treatment in 77.3%. Adhesiolysis/section of fibrous bands (55.7%), detorsion (14.3%) and resection anastomosis (11.9%) were the most common surgical procedures. Overall morbidity was 11.6%, dominated by surgical site infection (7.14%). The mean resumption of intestinal transit was 2.7 days, and the mean hospital stay was 7.9 days. Overall mortality was 6.7%. Conclusion: Acute intestinal obstruction is a frequent, absolute medical-surgical emergency, with multiple etiologies dominated in our series by adhesions and/or fibrous bands, whose morbi-mortality could be reduced by early and appropriate management before the onset of intestinal necrosis.展开更多
Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hos...Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.展开更多
Introduction: Tuberculosis is an infectious disease that mainly affects the lung. Extrapulmonary localizations are a reason for hospitalization in our health facilities. The objective of this study was to describe the...Introduction: Tuberculosis is an infectious disease that mainly affects the lung. Extrapulmonary localizations are a reason for hospitalization in our health facilities. The objective of this study was to describe the epidemiological, clinical, paraclinical and evolutionary aspects of extra pulmonary tuberculosis (EPT) at the Abass Ndao Hospital Center. Patients and Methods: This was a descriptive cross-sectional study conducted over a period of 11 years (January 1, 2010 to December 30, 2021). All patients with extrapulmonary tuberculosis hospitalized in the department of internal medicine during the recruitment period were included. Results: Fifty-two (52) patients were collected. The year 2019 recorded the most cases 23.08% (n = 20). The mean age of the patients was 40.56 ± 18.24 years. The age group 20 - 34 years 42.31% (n = 22) was the most represented. Females were in the majority 61.54% (n = 32) with a sex ratio (M/F) was 0.63. Housewives were in the majority 40.38% (n = 21). 60.87% of the cases (n = 14) came from a health facility. 38.46% of the cases had been infected. 21.74% (n = 9) were smokers. The reasons for consultation were dominated by fever (67.44%), AEG (62.79%) and cough (41.86%). Eighteen patients (40.91%) had fever. The mean time to consultation was 77.37 ± 90.3 days with extremes of 3 and 365 days. The median was 45 days. More than half of the patients 61.90% (n = 26) had anemia. Positive retroviral serology was noted in 21.43% of cases. All patients had a CRP greater than 6. More than half of the patients 51.92% (n = 27) had multifocal tuberculosis. The peritoneum 44.23% (n = 23) was the main organ affected. The average hospital stay was 9.8 ± 4.9 days with extremes of 1 and 19 days. All patients had received the protocol in force at the national level. Death was noted in 4 patients (9.52%). Conclusion: EPT is characterized in our context by a notorious diagnostic difficulty due to the multiplicity of clinical presentations, the complexity of explorations, and the problems of differential diagnosis notably with other granulomatosis, systemic lupus and cancers. This difficulty is reflected in the low rate of diagnosis with a paraclinical argument of certainty and in the long diagnostic delays.展开更多
Introduction: Sickle cell disease (SCD) is the most common genetic disease in the world. Vitamin D deficiency has been described in several patients with this disease. We report the case of a patient in whom osteomala...Introduction: Sickle cell disease (SCD) is the most common genetic disease in the world. Vitamin D deficiency has been described in several patients with this disease. We report the case of a patient in whom osteomalacia revealed the disease. Observation: The patient was 35 years old, not an alcoholic, not exposed to toxic products, with a family history of sickle cell disease in her 4 brothers and sisters. She reports the appearance of diffuse bone pain but which predominates in the axial skeleton, the ribs and the rhizomelic zones having motivated several hospitalizations. These pains are recurrent with new attacks on the lumbar spine, and sacroiliac joints with intense pain. Paraclinical examinations revealed: normal long bone radiographs without bone lysis, a CT scan of the sacroiliac joints without any aspect of sacroiliitis, but revealing multiple vertebral condensing bone lesions in streaks, diffuse at the level of the iliac wings with osteolysis surrounded by non aggressive osteocondensation. Densitometry was normal, vitamin D deficiency was noted at 29 ng/mL with elevated alkaline phosphatase, normal concentrations of Calcemia and Phosphoremia respectively at 96 mg/L and 36 mg/L, contrasting with hyperparathyroidism with a blood level of parathyroid hormone elevated to twice the normal level at 104.4 pg/mL It should be noted that the patient had received per os vitamin D supplementation before coming to us. The diagnosis of osteomalacia secondary to vitamin D deficiency complicated by secondary hyperparathyroidism was retained. Given the family history, we looked for the existence of sickle cell disease which was finally confirmed on hemoglobin electrophoresis with an AS profile. Conclusion: The association between vitamin D deficiency and sickle cell disease is not uncommon, and is explained by the ethnic origin, race, skin color, genetics and physiological features of patients with this disease rather than the disease itself.展开更多
Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our c...Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1<sup>st</sup>, 2019 to August 31<sup>st</sup>, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.展开更多
Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutio...Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutionary aspects. Materials and Methods: This was a cross-sectional, descriptive study, conducted over 5 years (from January 01, 2018 to December 31, 2022) at the National Abass Ndao Hospital Center and including all confirmed cases of primary hyperparathyroidism. Results: Twenty-nine patients were included with a female predominance (86.20%) and an average age of 48.10 ± 18.93 years. The discovery of hyperparathyroidism was fortuitous in 79.31% of cases. The main clinical manifestations were osteoarticular (62%) and urinary (34.5%). On average, serum calcium measured was 109.2 ± 7.92 mg/l, corrected serum calcium 111.3 ± 6.25 mg/l, urinary calcium 421.9 ± 96.45 mg/24h and parathormone at 145 ± 159.71 pg/ml. Among the patients, 25 had hypercalcemia (86.2%) and all had 24-hour hypercalciuria. The diagnosis was retained in view of the elevated parathyroid hormone (PTH) values in all patients. Cervical ultrasound objectified a parathyroid adenoma in 27.58% of cases and 12 patients or 46.2% had presented a scintigraphy in favor of a parathyroid adenoma. We found 01 cases of multiple endocrine neoplasia type 2. Bone densitometry performed in 10 patients found osteoporosis in 60% of cases (6 patients) and osteopenia in 40% of cases (4 patients). Surgical treatment was performed in 12 patients (41.4%). The histology of the surgical specimens was in favor of a parathyroid adenoma in all cases. Among the operated patients, the evolution was marked by a cure rate of 100%. Conclusion: The symptomatology of primary hyperparathyroidism remains mainly osteoarticular and urinary. Surgery has proven its effectiveness in our series. We insist on the systematic dosage of calcemia especially in women over 50 years and the promotion of morphological explorations.展开更多
Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study condu...Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study conducted from 1 January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals and the endocrinology department of the Abass Ndao Hospital. Results: We included 89 patients, representing a prevalence of 36.7% among all cases of pituitary adenoma. The mean age was 35.6 ± 10 years and the sex ratio was 0.34. The mean time to consultation was 27.1 ± 29 months. Clinical symptoms were dominated by gonadotropic disorders represented by galactorrhoea (71 cases, 79.8%), amenorrhoea (61 cases, 68.5%), and infertility in the couple (31 cases, 34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%, including 57 cases of headache (64%), 34 cases of visual disorders (38.2%) and 8 patients with a dysmorphic syndrome (8.9%). Imaging revealed a macroadenoma in 68.5% (61 cases) and extension of the adenoma in 11 patients (12.4%). The hormonal profile was isolated lactotropic hypersecretion (80 cases, 89.9%) and mixed in 9 cases (including concomitant secretion of GH in 8 cases and ACTH in 1 case). All patients had initially benefited? from dopaminergic agonist-based medical treatment. Pituitary surgery was effective in 45 patients (50.6%), including 44 cases by transsphenoidal approach. Postoperative incidents included transient diabetes insipidus (77.7%) and cerebrospinal fluid leakage (20%). We noted 7 cases (7.9%) of death presenting with a tumour syndrome (100%), a macro-adenoma (85.7%), having undergone pituitary surgery (42.9%). The factors significantly associated with prolactinoma were young age (p Conclusion: This series also demonstrates the impact of prolactin adenomas on reproductive function. Delayed diagnosis explains the predominance of macroadenomas, which are a source of pre- and post-operative complications.展开更多
<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this s...<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). <strong>Materials and Methods: </strong>This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded;they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, <em>i.e.</em> in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. <strong>Results:</strong> Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. <strong>Conclusion:</strong> Autoimmune thyroiditis is common in our daily practice in Senegal;it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.展开更多
We present a 27-year-old female patient received for epistaxis associated with gingivorrhagia. In her medical history, she had undergone an oesogastroduodenal fibroscopy one year earlier, which revealed a bulbar ulcer...We present a 27-year-old female patient received for epistaxis associated with gingivorrhagia. In her medical history, she had undergone an oesogastroduodenal fibroscopy one year earlier, which revealed a bulbar ulcer with gastritis. On admission, she presented with a bleeding syndrome, an anemic syndrome with poor hemodynamic tolerance, and epigastric sensitivity. The blood count performed in the emergency on the citrate tube showed a bicy-topenia (regenerative anemia + thrombocytopenia). The HELIKIT test was positive. Thus, the hypothesis of an acute immunological thrombocytopenic purpura associated with a Helicobacter pylori infection seemed to us the most probable with a Khellaf hemorrhagic score of 8. She had benefited from a bolus of methyl prednisone: 15 mg/kg/day for 3 days then relay per os with prednisone 1 mg/kg/day (and adjuvant treatment);the eradicating treatment of Helicobacter pylori had been simultaneously started.展开更多
Rosai Dorfman’s Disease (RDD) Destombes also called sinus histiocytosis with massive lymphadenopathy is a lymphoproliferative pathology usually benign, of unknown etiology, and of low incidence. It is a rare, but wel...Rosai Dorfman’s Disease (RDD) Destombes also called sinus histiocytosis with massive lymphadenopathy is a lymphoproliferative pathology usually benign, of unknown etiology, and of low incidence. It is a rare, but well-defined clinicopathological entity, which predominantly affects children and adolescents without distinction of gender or race. It manifests itself generally by bulky cervical lymphadenopathies, most often bilateral, painless, of benign but persistent evolution and a long-term fever associated with a non-specific biological inflammatory syndrome. Extra lymph node locations are described in association with lymph node involvement or isolation. The definitive diagnosis of Rosai Dorfman’s disease is histological, characterized by histiocytic infiltration with emperipolesis essentially of lymphocytes. The etiopathogenesis of the condition remains unclear, based on infectious and immunological hypotheses without clear evidence. The management is not well codified, it combines depending on the case, surgery;corticosteroids;antimetabolites and interferon alpha. Studies devoted to this condition in tropical Africa are rare. We report the clinical and progressive features of 5 observations of Rosai Dorfman’s disease.展开更多
Introduction: Plasma cell leukemia (PL) is a rare lymphoproliferative disorder characterized by the monoclonal proliferation of plasma cells in the marrow and blood peripheral. It is defined by a blood plasmacytosis g...Introduction: Plasma cell leukemia (PL) is a rare lymphoproliferative disorder characterized by the monoclonal proliferation of plasma cells in the marrow and blood peripheral. It is defined by a blood plasmacytosis greater than 2 G/l or a plasma cell level greater than 20% of leukocytes. It can be primitive or secondary to multiple myeloma (MM). We reported 3 cases of PL. Observations: Case 1: A 59 years old woman with fever, anemia with 7 g/dl, hyperleukocytosis 9200/mm<sup>3</sup>, thrombopenia 86 G/l inflammatory biological syndrome with CRP at 129 mg/l, hypercalcemia at 120 mg/l, renal failure with serum creatinine at 35 mg/l, urea at 0.85 g/l and 24-hour proteinuria at 0.98 g/24h. Β2 microglobulin at 10.34 mg/l. The blood smear shows dysmorphic plasma cells at 68% and the bone marrow at 79% of dysmorphic plasma cells. The immunophenotyping of blood cells, the electrophoretic serum protein, shows PL CD38+, secondary of a MM LAMBDA. Case 2: A 65-year-old man with type 2 diabetes presented, right femoral neck, anemia, hyperleukocytosis at 22 G/l, and thrombocytopenia at 99 G/l. There was no hypercalcemia, or kidney failure. The blood smear showed 28% of plasma cells and 9% of blasts. On the myelogram, the marrow was normal richness with significant medullary plasmacytosis (31%) made up of dysmorphic plasma cells. The CT scan showed a settling of the body of D5 with heterogeneous osteocondensation. The patient was transferred to hematology where she was treated with polychemotherapy. The evolution was unfavorable following a death due to malignant hypercalcemia. Case 3: A 62-year-old woman who had a 5-year follow-up of Ig G kappa multiple myeloma was treated with Melphalan, Prednisone, and thalidomide with a therapeutic break for 2 months. She came back to the Internal Medicine department with: severe global dehydration, anemia with externalized bleeding gingivorrhagia, pain in mechanical bones of the ribs, lower limbs, and pelvis, bilateral pneumonia. The biology found hyperleukocytosis at 99 G/l, anemia at 4.7 g/dl, thrombocytopenia at 31 g/l, hypercalcemia at 190 mg/l, renal failure with creatinine at 34 mg/L, and urea at 1.08 g/l, a biological inflammatory syndrome with CRP 294 mg/l. The smeared blood had shown 93% blood plasma cells and immunophenotyping showed CD38+. The patient died before specific treatment for the disease. Conclusion: Plasma cell leukemia is a rare atypical variant, complicating essentially multiple light chain myeloma. She must be suspected especially when there are cytological abnormalities such as major leukocytosis or thrombocytopenia, which are unusual in classical myeloma. Evolution is usually a very bad prognosis, with a median survival of 12 to 14 months for the form primary and 2 to 3 months for the secondary form.展开更多
Introduction: Immunosenescence contributes to the development of auto-antibodies. However, while the prevalence of some autoantibodies increases with age, the incidence of connective tissue diseases decreases with age...Introduction: Immunosenescence contributes to the development of auto-antibodies. However, while the prevalence of some autoantibodies increases with age, the incidence of connective tissue diseases decreases with age. This study aims to determine the clinical and paraclinical characteristics of connective tissue diseases in the elderly population. Materials and Methods: We conducted a retrospective and descriptive study, from March 2010 to March 2021, in the Internal Medicine Department of Aristide Le Dantec Hospital, including all the medical records of patients followed up for connective tissue disease and whose symptomatology began at an age greater than or equal to 65 years. Epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected from a pre-established survey form and then processed using SPSS software. Results: Overall, 22 cases were collected out of 275 seen on consultation. They involved 16 women and 6 men, aged between 65 and 85 years with a median of 70 years. The mean duration of the clinical picture was 15.7 months with extremes of 1 and 96 months. The clinical symptoms were joint pain in 21 patients associated with dry eye and mouth syndrome in seven cases and one patient underwent isolated dry eye and mouth syndrome. Joint involvement was deforming in 13 patients. Poor general condition was noted in 20 patients. Biology showed anemia in 14 patients, hyperleukocytosis (2 patients) and thrombocytosis (5 patients). The sedimentation rate (SR) was accelerated in 9 patients and the C-reactive protein (CRP) was positive in 12 patients. Immunology showed a positive Latex test (3 patients/6), Waaler-Rose reaction (8 patients/13), anti-cyclic citrullinated peptides (anti-CCP) antibodies (11 patients/11), anti-nuclear antibodies (2 patients/4). Anti-extractable nuclear antigens (anti-ENA) antibody testing in 4 patients showed positive anti-U1RNP (1 case), anti-SSA and anti-SSB (1 case). Plain X-Rays of the hands, wrists and feet showed destructive lesions in 16 patients. The diagnosis of rheumatoid arthritis (RA) was set in 21 patients, one of which was associated with Sjogren’s syndrome (SS) and one with primary Sjogren’s syndrome. Treatment was based on prednisone (21 cases), methotrexate (17 patients), and hydroxychloroquine (9 patients). The evolution was remarkable in 10 patients. Conclusion: Autoimmune diseases in the elderly are uncommon compared to the young adult population. In our study, we only found cases of rheumatoid arthritis and Sjogren’s syndrome. As the population ages, connective tissue diseases may be increasingly diagnosed.展开更多
Introduction: The COVID-19 pandemic has turned the global health system upside down. Senegal recorded its first case on 2 March 2020. As part of its control strategy, the internal medicine department was set up as an ...Introduction: The COVID-19 pandemic has turned the global health system upside down. Senegal recorded its first case on 2 March 2020. As part of its control strategy, the internal medicine department was set up as an epidemic treatment center (ETC). We report on our experience in the management of patients hospitalized in the said center. Material and Methods: Retrospective and descriptive study with analytical aim carried out at the ETC of the CHU Le Dantec of Dakar during the period from 29 April to 30 October 2020 (1st wave) then from 30 December 2020 to 30 April 2021 (2nd wave). All hospitalized patients who tested positive for RT-PCR were included. Epidemiological, clinical, paraclinical and evolutionary data were collected from a pre-established survey form and analysed using the software. Results: Five hundred and seventy files were collected: 379 patients (66%) in the 1st wave and 191 patients (34%) in the 2nd wave. There were 312 men and 258 women, i.e. a sex ratio of 1.22. The median age was 56 years [1.5 - 100 years]. Two thirds of the patients (66%) were over 50 years of age and 223 patients (39.1%) were over 65 years of age. Community transmission was reported in 72% of cases. The average length of hospital stay was 10 days [1 - 32]. Clinically, the mild form predominated (50.9%);the severe and critical forms were 32.6%. Comorbidity was noted in 68% of patients. The different comorbidities were: hypertension (36.1%), diabetes (28.2%), advanced CKD (9.8%). The case fatality rate was 17.2% with a mean age of 70 years. Conclusion: COVID-19 is responsible for respiratory but also systemic manifestations. This 3rd pandemic particularly affects vulnerable people with a significant morbidity and mortality, thus requiring the implementation of standardized CTE with multidisciplinary teams in the control strategies.展开更多
Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often desc...Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.展开更多
Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim...Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.展开更多
INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitte...INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitted for adenopathy in order to identify their specificities. METHODS: This was an observational study of a transverse and descriptive type, which took place from 1 July 2015 to 30 June 2016 in the internal medicine department of the Aristide Le Dantec national hospital in Dakar. RESULTS: We identified 84 patients, consisted of 46 male and 38 female. The sex ratio was 1.2. The mean age was 37.5 years. The consultation period was on average 2 months with extremes of 1 month and 1 year. The mean hospital stay was 29. 2 days with extremes of 1 week and 2 months. The etiologies found were classified into 6 groups. Hemopathies (30.9%) were dominated by acute leukemia in 8 patients (9.52%), non-Hodgkin’s lymphoma in 9 patients (9.5%), Hodgkin’s disease in 5 patients (5.9%). Chronic lymphocytic leukemia was retained in 3 patients (3.5%) and Castleman disease in 1 patient. Systemic diseases (11.9%) were divided into lupus disease in 4 patients and rheumatoid arthritis in 4 patients, one case of Sj?gren’s syndrome and one case of sarcoidosis. Infections were very frequent in our study, found in 34 patients (40.4%). Tuberculosis was more frequent (27.3%). The association with HIV was noted in 4 patients. The other infections were pyogenic in 3 patients (3.5%), HIV in 6 patients (7.1%), Borrelia and toxoplasma in 1 patient respectively. Cancers (8.3%) were metastatic of primary tumors including the esophagus, lung, prostate, cavum, stomach, pancreas and breast, one case each. One patient presented lymphadenopathy with inguinal localization, the etiology of which was found to be thrombophlebitis of the right lower limb. The hystiocytic pathologies (3.5%) were all related to lymphohystiocytic activation syndrome (LHAS) secondary to tuberculosis in 2 patients and pyomyositis in 1 patient. The difficulties encountered were mainly the inaccessibility of certain complementary examinations and the delay in obtaining the results. CONCLUSION: Adenopathies are a very common reason for consultation in internal medicine. This study allowed us to draw up the etiological profile of adenopathies in our practice but also to identify the main difficulties which are among other things the inaccessibility of certain complementary examinations.展开更多
文摘Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hospital establishments in Ziguinchor. Materials and Methods: This was a retrospective, descriptive, multicenter study from the period of January 1, 2017 to December 31, 2021. Patients over 15 years of age admitted for occlusive syndrome in the two surgical departments of the Ziguinchor regional hospitals were included in the study. Epidemiological, diagnostic, therapeutic and evolutionary data were studied. Results: Acute intestinal occlusions accounted for 8.3% of admissions. A total of 163 patients were enrolled, 61.9% were men, sex ratio of 1.6. The mean age was 48.7 years. The average consultation time was 74.8 hours (3.12 days). The total occlusive syndrome was in 48.5% of the cases. Abdominal pain was present in 87.1%, vomiting in 74.2%, cessation of matter and gas in 60.7% and meteorism in 36.2%. Biological lab tests reported hyperleukocytosis in 28.1% of the cases. Abdominal CT scans were performed in 71.2%, confirming the diagnosis in 90.5% and determining the etiology in 93.1%. The zone of the obstruction in the small bowel was 62.7%, and in the colon in 37.3%. Functional occlusions accounted for 22.7% of cases and mechanical for 77.3%, including 120 cases of strangulation occlusion (95.2%) and 6 cases of obstruction. Etiologies were dominated by adhesions and/or fibrous bands (61.2%). Medical treatment resolved the occlusive syndrome in 9.2% of cases, instrumental treatment in 17.1% and surgical treatment in 77.3%. Adhesiolysis/section of fibrous bands (55.7%), detorsion (14.3%) and resection anastomosis (11.9%) were the most common surgical procedures. Overall morbidity was 11.6%, dominated by surgical site infection (7.14%). The mean resumption of intestinal transit was 2.7 days, and the mean hospital stay was 7.9 days. Overall mortality was 6.7%. Conclusion: Acute intestinal obstruction is a frequent, absolute medical-surgical emergency, with multiple etiologies dominated in our series by adhesions and/or fibrous bands, whose morbi-mortality could be reduced by early and appropriate management before the onset of intestinal necrosis.
文摘Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.
文摘Introduction: Tuberculosis is an infectious disease that mainly affects the lung. Extrapulmonary localizations are a reason for hospitalization in our health facilities. The objective of this study was to describe the epidemiological, clinical, paraclinical and evolutionary aspects of extra pulmonary tuberculosis (EPT) at the Abass Ndao Hospital Center. Patients and Methods: This was a descriptive cross-sectional study conducted over a period of 11 years (January 1, 2010 to December 30, 2021). All patients with extrapulmonary tuberculosis hospitalized in the department of internal medicine during the recruitment period were included. Results: Fifty-two (52) patients were collected. The year 2019 recorded the most cases 23.08% (n = 20). The mean age of the patients was 40.56 ± 18.24 years. The age group 20 - 34 years 42.31% (n = 22) was the most represented. Females were in the majority 61.54% (n = 32) with a sex ratio (M/F) was 0.63. Housewives were in the majority 40.38% (n = 21). 60.87% of the cases (n = 14) came from a health facility. 38.46% of the cases had been infected. 21.74% (n = 9) were smokers. The reasons for consultation were dominated by fever (67.44%), AEG (62.79%) and cough (41.86%). Eighteen patients (40.91%) had fever. The mean time to consultation was 77.37 ± 90.3 days with extremes of 3 and 365 days. The median was 45 days. More than half of the patients 61.90% (n = 26) had anemia. Positive retroviral serology was noted in 21.43% of cases. All patients had a CRP greater than 6. More than half of the patients 51.92% (n = 27) had multifocal tuberculosis. The peritoneum 44.23% (n = 23) was the main organ affected. The average hospital stay was 9.8 ± 4.9 days with extremes of 1 and 19 days. All patients had received the protocol in force at the national level. Death was noted in 4 patients (9.52%). Conclusion: EPT is characterized in our context by a notorious diagnostic difficulty due to the multiplicity of clinical presentations, the complexity of explorations, and the problems of differential diagnosis notably with other granulomatosis, systemic lupus and cancers. This difficulty is reflected in the low rate of diagnosis with a paraclinical argument of certainty and in the long diagnostic delays.
文摘Introduction: Sickle cell disease (SCD) is the most common genetic disease in the world. Vitamin D deficiency has been described in several patients with this disease. We report the case of a patient in whom osteomalacia revealed the disease. Observation: The patient was 35 years old, not an alcoholic, not exposed to toxic products, with a family history of sickle cell disease in her 4 brothers and sisters. She reports the appearance of diffuse bone pain but which predominates in the axial skeleton, the ribs and the rhizomelic zones having motivated several hospitalizations. These pains are recurrent with new attacks on the lumbar spine, and sacroiliac joints with intense pain. Paraclinical examinations revealed: normal long bone radiographs without bone lysis, a CT scan of the sacroiliac joints without any aspect of sacroiliitis, but revealing multiple vertebral condensing bone lesions in streaks, diffuse at the level of the iliac wings with osteolysis surrounded by non aggressive osteocondensation. Densitometry was normal, vitamin D deficiency was noted at 29 ng/mL with elevated alkaline phosphatase, normal concentrations of Calcemia and Phosphoremia respectively at 96 mg/L and 36 mg/L, contrasting with hyperparathyroidism with a blood level of parathyroid hormone elevated to twice the normal level at 104.4 pg/mL It should be noted that the patient had received per os vitamin D supplementation before coming to us. The diagnosis of osteomalacia secondary to vitamin D deficiency complicated by secondary hyperparathyroidism was retained. Given the family history, we looked for the existence of sickle cell disease which was finally confirmed on hemoglobin electrophoresis with an AS profile. Conclusion: The association between vitamin D deficiency and sickle cell disease is not uncommon, and is explained by the ethnic origin, race, skin color, genetics and physiological features of patients with this disease rather than the disease itself.
文摘Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1<sup>st</sup>, 2019 to August 31<sup>st</sup>, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.
文摘Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutionary aspects. Materials and Methods: This was a cross-sectional, descriptive study, conducted over 5 years (from January 01, 2018 to December 31, 2022) at the National Abass Ndao Hospital Center and including all confirmed cases of primary hyperparathyroidism. Results: Twenty-nine patients were included with a female predominance (86.20%) and an average age of 48.10 ± 18.93 years. The discovery of hyperparathyroidism was fortuitous in 79.31% of cases. The main clinical manifestations were osteoarticular (62%) and urinary (34.5%). On average, serum calcium measured was 109.2 ± 7.92 mg/l, corrected serum calcium 111.3 ± 6.25 mg/l, urinary calcium 421.9 ± 96.45 mg/24h and parathormone at 145 ± 159.71 pg/ml. Among the patients, 25 had hypercalcemia (86.2%) and all had 24-hour hypercalciuria. The diagnosis was retained in view of the elevated parathyroid hormone (PTH) values in all patients. Cervical ultrasound objectified a parathyroid adenoma in 27.58% of cases and 12 patients or 46.2% had presented a scintigraphy in favor of a parathyroid adenoma. We found 01 cases of multiple endocrine neoplasia type 2. Bone densitometry performed in 10 patients found osteoporosis in 60% of cases (6 patients) and osteopenia in 40% of cases (4 patients). Surgical treatment was performed in 12 patients (41.4%). The histology of the surgical specimens was in favor of a parathyroid adenoma in all cases. Among the operated patients, the evolution was marked by a cure rate of 100%. Conclusion: The symptomatology of primary hyperparathyroidism remains mainly osteoarticular and urinary. Surgery has proven its effectiveness in our series. We insist on the systematic dosage of calcemia especially in women over 50 years and the promotion of morphological explorations.
文摘Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study conducted from 1 January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals and the endocrinology department of the Abass Ndao Hospital. Results: We included 89 patients, representing a prevalence of 36.7% among all cases of pituitary adenoma. The mean age was 35.6 ± 10 years and the sex ratio was 0.34. The mean time to consultation was 27.1 ± 29 months. Clinical symptoms were dominated by gonadotropic disorders represented by galactorrhoea (71 cases, 79.8%), amenorrhoea (61 cases, 68.5%), and infertility in the couple (31 cases, 34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%, including 57 cases of headache (64%), 34 cases of visual disorders (38.2%) and 8 patients with a dysmorphic syndrome (8.9%). Imaging revealed a macroadenoma in 68.5% (61 cases) and extension of the adenoma in 11 patients (12.4%). The hormonal profile was isolated lactotropic hypersecretion (80 cases, 89.9%) and mixed in 9 cases (including concomitant secretion of GH in 8 cases and ACTH in 1 case). All patients had initially benefited? from dopaminergic agonist-based medical treatment. Pituitary surgery was effective in 45 patients (50.6%), including 44 cases by transsphenoidal approach. Postoperative incidents included transient diabetes insipidus (77.7%) and cerebrospinal fluid leakage (20%). We noted 7 cases (7.9%) of death presenting with a tumour syndrome (100%), a macro-adenoma (85.7%), having undergone pituitary surgery (42.9%). The factors significantly associated with prolactinoma were young age (p Conclusion: This series also demonstrates the impact of prolactin adenomas on reproductive function. Delayed diagnosis explains the predominance of macroadenomas, which are a source of pre- and post-operative complications.
文摘<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). <strong>Materials and Methods: </strong>This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded;they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, <em>i.e.</em> in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. <strong>Results:</strong> Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. <strong>Conclusion:</strong> Autoimmune thyroiditis is common in our daily practice in Senegal;it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.
文摘We present a 27-year-old female patient received for epistaxis associated with gingivorrhagia. In her medical history, she had undergone an oesogastroduodenal fibroscopy one year earlier, which revealed a bulbar ulcer with gastritis. On admission, she presented with a bleeding syndrome, an anemic syndrome with poor hemodynamic tolerance, and epigastric sensitivity. The blood count performed in the emergency on the citrate tube showed a bicy-topenia (regenerative anemia + thrombocytopenia). The HELIKIT test was positive. Thus, the hypothesis of an acute immunological thrombocytopenic purpura associated with a Helicobacter pylori infection seemed to us the most probable with a Khellaf hemorrhagic score of 8. She had benefited from a bolus of methyl prednisone: 15 mg/kg/day for 3 days then relay per os with prednisone 1 mg/kg/day (and adjuvant treatment);the eradicating treatment of Helicobacter pylori had been simultaneously started.
文摘Rosai Dorfman’s Disease (RDD) Destombes also called sinus histiocytosis with massive lymphadenopathy is a lymphoproliferative pathology usually benign, of unknown etiology, and of low incidence. It is a rare, but well-defined clinicopathological entity, which predominantly affects children and adolescents without distinction of gender or race. It manifests itself generally by bulky cervical lymphadenopathies, most often bilateral, painless, of benign but persistent evolution and a long-term fever associated with a non-specific biological inflammatory syndrome. Extra lymph node locations are described in association with lymph node involvement or isolation. The definitive diagnosis of Rosai Dorfman’s disease is histological, characterized by histiocytic infiltration with emperipolesis essentially of lymphocytes. The etiopathogenesis of the condition remains unclear, based on infectious and immunological hypotheses without clear evidence. The management is not well codified, it combines depending on the case, surgery;corticosteroids;antimetabolites and interferon alpha. Studies devoted to this condition in tropical Africa are rare. We report the clinical and progressive features of 5 observations of Rosai Dorfman’s disease.
文摘Introduction: Plasma cell leukemia (PL) is a rare lymphoproliferative disorder characterized by the monoclonal proliferation of plasma cells in the marrow and blood peripheral. It is defined by a blood plasmacytosis greater than 2 G/l or a plasma cell level greater than 20% of leukocytes. It can be primitive or secondary to multiple myeloma (MM). We reported 3 cases of PL. Observations: Case 1: A 59 years old woman with fever, anemia with 7 g/dl, hyperleukocytosis 9200/mm<sup>3</sup>, thrombopenia 86 G/l inflammatory biological syndrome with CRP at 129 mg/l, hypercalcemia at 120 mg/l, renal failure with serum creatinine at 35 mg/l, urea at 0.85 g/l and 24-hour proteinuria at 0.98 g/24h. Β2 microglobulin at 10.34 mg/l. The blood smear shows dysmorphic plasma cells at 68% and the bone marrow at 79% of dysmorphic plasma cells. The immunophenotyping of blood cells, the electrophoretic serum protein, shows PL CD38+, secondary of a MM LAMBDA. Case 2: A 65-year-old man with type 2 diabetes presented, right femoral neck, anemia, hyperleukocytosis at 22 G/l, and thrombocytopenia at 99 G/l. There was no hypercalcemia, or kidney failure. The blood smear showed 28% of plasma cells and 9% of blasts. On the myelogram, the marrow was normal richness with significant medullary plasmacytosis (31%) made up of dysmorphic plasma cells. The CT scan showed a settling of the body of D5 with heterogeneous osteocondensation. The patient was transferred to hematology where she was treated with polychemotherapy. The evolution was unfavorable following a death due to malignant hypercalcemia. Case 3: A 62-year-old woman who had a 5-year follow-up of Ig G kappa multiple myeloma was treated with Melphalan, Prednisone, and thalidomide with a therapeutic break for 2 months. She came back to the Internal Medicine department with: severe global dehydration, anemia with externalized bleeding gingivorrhagia, pain in mechanical bones of the ribs, lower limbs, and pelvis, bilateral pneumonia. The biology found hyperleukocytosis at 99 G/l, anemia at 4.7 g/dl, thrombocytopenia at 31 g/l, hypercalcemia at 190 mg/l, renal failure with creatinine at 34 mg/L, and urea at 1.08 g/l, a biological inflammatory syndrome with CRP 294 mg/l. The smeared blood had shown 93% blood plasma cells and immunophenotyping showed CD38+. The patient died before specific treatment for the disease. Conclusion: Plasma cell leukemia is a rare atypical variant, complicating essentially multiple light chain myeloma. She must be suspected especially when there are cytological abnormalities such as major leukocytosis or thrombocytopenia, which are unusual in classical myeloma. Evolution is usually a very bad prognosis, with a median survival of 12 to 14 months for the form primary and 2 to 3 months for the secondary form.
文摘Introduction: Immunosenescence contributes to the development of auto-antibodies. However, while the prevalence of some autoantibodies increases with age, the incidence of connective tissue diseases decreases with age. This study aims to determine the clinical and paraclinical characteristics of connective tissue diseases in the elderly population. Materials and Methods: We conducted a retrospective and descriptive study, from March 2010 to March 2021, in the Internal Medicine Department of Aristide Le Dantec Hospital, including all the medical records of patients followed up for connective tissue disease and whose symptomatology began at an age greater than or equal to 65 years. Epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected from a pre-established survey form and then processed using SPSS software. Results: Overall, 22 cases were collected out of 275 seen on consultation. They involved 16 women and 6 men, aged between 65 and 85 years with a median of 70 years. The mean duration of the clinical picture was 15.7 months with extremes of 1 and 96 months. The clinical symptoms were joint pain in 21 patients associated with dry eye and mouth syndrome in seven cases and one patient underwent isolated dry eye and mouth syndrome. Joint involvement was deforming in 13 patients. Poor general condition was noted in 20 patients. Biology showed anemia in 14 patients, hyperleukocytosis (2 patients) and thrombocytosis (5 patients). The sedimentation rate (SR) was accelerated in 9 patients and the C-reactive protein (CRP) was positive in 12 patients. Immunology showed a positive Latex test (3 patients/6), Waaler-Rose reaction (8 patients/13), anti-cyclic citrullinated peptides (anti-CCP) antibodies (11 patients/11), anti-nuclear antibodies (2 patients/4). Anti-extractable nuclear antigens (anti-ENA) antibody testing in 4 patients showed positive anti-U1RNP (1 case), anti-SSA and anti-SSB (1 case). Plain X-Rays of the hands, wrists and feet showed destructive lesions in 16 patients. The diagnosis of rheumatoid arthritis (RA) was set in 21 patients, one of which was associated with Sjogren’s syndrome (SS) and one with primary Sjogren’s syndrome. Treatment was based on prednisone (21 cases), methotrexate (17 patients), and hydroxychloroquine (9 patients). The evolution was remarkable in 10 patients. Conclusion: Autoimmune diseases in the elderly are uncommon compared to the young adult population. In our study, we only found cases of rheumatoid arthritis and Sjogren’s syndrome. As the population ages, connective tissue diseases may be increasingly diagnosed.
文摘Introduction: The COVID-19 pandemic has turned the global health system upside down. Senegal recorded its first case on 2 March 2020. As part of its control strategy, the internal medicine department was set up as an epidemic treatment center (ETC). We report on our experience in the management of patients hospitalized in the said center. Material and Methods: Retrospective and descriptive study with analytical aim carried out at the ETC of the CHU Le Dantec of Dakar during the period from 29 April to 30 October 2020 (1st wave) then from 30 December 2020 to 30 April 2021 (2nd wave). All hospitalized patients who tested positive for RT-PCR were included. Epidemiological, clinical, paraclinical and evolutionary data were collected from a pre-established survey form and analysed using the software. Results: Five hundred and seventy files were collected: 379 patients (66%) in the 1st wave and 191 patients (34%) in the 2nd wave. There were 312 men and 258 women, i.e. a sex ratio of 1.22. The median age was 56 years [1.5 - 100 years]. Two thirds of the patients (66%) were over 50 years of age and 223 patients (39.1%) were over 65 years of age. Community transmission was reported in 72% of cases. The average length of hospital stay was 10 days [1 - 32]. Clinically, the mild form predominated (50.9%);the severe and critical forms were 32.6%. Comorbidity was noted in 68% of patients. The different comorbidities were: hypertension (36.1%), diabetes (28.2%), advanced CKD (9.8%). The case fatality rate was 17.2% with a mean age of 70 years. Conclusion: COVID-19 is responsible for respiratory but also systemic manifestations. This 3rd pandemic particularly affects vulnerable people with a significant morbidity and mortality, thus requiring the implementation of standardized CTE with multidisciplinary teams in the control strategies.
文摘Graves’ disease and Hashimoto’s thyroiditis are two common autoimmune diseases. Their association with other autoimmune diseases is not exceptional. However, the co-occurrence of these two diseases is not often described. In this case, report, we describe the observation of a patient who had long been followed for exophthalmos and pretibial myxedema as a sign of thyrotoxicosis. Examination of this patient revealed a clinical picture of clinical and biological hypothyroidism related to Hashimoto’s thyroiditis. This case had made it possible to retain an association between Hashimoto’s thyroiditis and basedowdisease, which is rarely described. This observation underscores the importance of monitoring these patients with autoimmune disease systematically even if there is no clinical manifestation.
文摘Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.
文摘INTRODUCTION: An adenopathy is a pathological hypertrophy of a lymph node of various etiologies requiring a rigorous approach. Thus we proposed in this work to study the etiological particularities of patients admitted for adenopathy in order to identify their specificities. METHODS: This was an observational study of a transverse and descriptive type, which took place from 1 July 2015 to 30 June 2016 in the internal medicine department of the Aristide Le Dantec national hospital in Dakar. RESULTS: We identified 84 patients, consisted of 46 male and 38 female. The sex ratio was 1.2. The mean age was 37.5 years. The consultation period was on average 2 months with extremes of 1 month and 1 year. The mean hospital stay was 29. 2 days with extremes of 1 week and 2 months. The etiologies found were classified into 6 groups. Hemopathies (30.9%) were dominated by acute leukemia in 8 patients (9.52%), non-Hodgkin’s lymphoma in 9 patients (9.5%), Hodgkin’s disease in 5 patients (5.9%). Chronic lymphocytic leukemia was retained in 3 patients (3.5%) and Castleman disease in 1 patient. Systemic diseases (11.9%) were divided into lupus disease in 4 patients and rheumatoid arthritis in 4 patients, one case of Sj?gren’s syndrome and one case of sarcoidosis. Infections were very frequent in our study, found in 34 patients (40.4%). Tuberculosis was more frequent (27.3%). The association with HIV was noted in 4 patients. The other infections were pyogenic in 3 patients (3.5%), HIV in 6 patients (7.1%), Borrelia and toxoplasma in 1 patient respectively. Cancers (8.3%) were metastatic of primary tumors including the esophagus, lung, prostate, cavum, stomach, pancreas and breast, one case each. One patient presented lymphadenopathy with inguinal localization, the etiology of which was found to be thrombophlebitis of the right lower limb. The hystiocytic pathologies (3.5%) were all related to lymphohystiocytic activation syndrome (LHAS) secondary to tuberculosis in 2 patients and pyomyositis in 1 patient. The difficulties encountered were mainly the inaccessibility of certain complementary examinations and the delay in obtaining the results. CONCLUSION: Adenopathies are a very common reason for consultation in internal medicine. This study allowed us to draw up the etiological profile of adenopathies in our practice but also to identify the main difficulties which are among other things the inaccessibility of certain complementary examinations.
